Contents

IDBI Federal Life Insurance Co Ltd

Grievance Redressal Policy

Version 2.0
Last Updated 29th July 2009

Prepared By Approved By

Designation: VP - Operations Designation: COO and Head –Legal

secretarial & compliance
Signature: Signature:
 POLICY ON CUSTOMER GRIEVANCE REDRESSAL

1. Introduction

1.1. The purpose of this policy is to ensure that the customers are treated fairly at all times and
their grievances are dealt with in a prompt and efficient manner. The attempt is to
translate the company’s ethical values of enhancing customer experience through
dedicated relationship management, customer friendly approach and superior service
delivery, while dealing with a customer grievance.

1.2. To achieve the above objective, this policy prescribes:

1.2.1. The avenues available to the customer to lodge or escalate his grievance within
the company; and
1.2.2. The timelines within which each customer grievance is required to be resolved.

2. Avenues available to the customer

2.1. The company’s service strategy is to enable the customer to avail the services through
multiple avenues. The avenues available to the customer are:

2.1.1. Customer Care: The customer can contact the company’s Call Centre at the Toll
free Nos 1800 102 5005 ( non MTNL subscribers ) & 1800 22 1120 ( MTNL
subscribers)

2.1.2. E-mail: The customer can send a email at support@idbifederal.com

2.1.3. Branch: The customer can contact the local IDBI Federal Branch

2.1.4. Partner’s Branch: The customer can contact the nearest IDBI Bank or Federal
Bank branch to forward the grievance to IDBI Federal.

2.1.5. Customer may also send a letter to: IDBI Federal Life Insurance Co Ltd,
Tradeview, Oasis complex, Kamala City, P. B. Marg, Lower Parel ( West) Mumbai
400 013.

2.2. Customer Support executives shall record all grievance in the Company’s system to
monitor the quality of resolution as well as the turnaround time for resolution of the
grievances.
3. Process and Time frame for response:

3.1 The process for handling the grievance will be as follows

(a) The company shall send a written acknowledgement to the customer within 3
working days of the receipt of the grievance.
(b). The acknowledgement shall contain the name and designation of the officer who will
deal with the grievance.
(c). It shall also contain the details of the insurer’s grievance redressal procedure and
the time taken for resolution of disputes.
(d). Where the company resolves the complaint within 3 days, it may communicate the
resolution along with the acknowledgement.
(e). Where the grievance is not resolved within 3 working days, the company shall
resolve the grievance within 2 weeks of its receipt and send a final letter of resolution.
(g). Where, within 2 weeks, the company sends the complainant a written response
which offers redress or rejects the complaint and gives reasons for doing so,
(i). the company shall inform the complainant about how he or she may pursue
the complaint, if dissatisfied.
(ii). the company shall inform that it will regard the complaint as closed if it does
not receive a reply within 8 weeks from the date of receipt of response by
the insured or policyholder.

3.2 For each and every office of the company a system of grievance registration and
disposal is put in place

3.3 The company has an escalation matrix in place to ensure that unresolved complaints and
grievances are escalated to the next authority level.

3.4 If the Zonal Head or VP – Operations is unable to resolve the grievance, the same will be
escalated to the Grievance Redressal Officer at Head Office in Mumbai. If the Grievance
Officer is still unable to resolve the customer grievance, the same will again be escalated to
the Grievance Redressal Committee.

3.5 The Grievance Redressal Committee consisting of the Senior Management Members shall
review and resolve the customer complaints escalated to it.

3.6 If the customer is unsatisfied with the company’s efforts to resolve the grievance, he may
take the matter up with the Insurance Ombudsman within one year under the Redressal of
Public Grievances Rules, 1998.

3.7 The company has nominated the Manager – Customer & Sales Support to be the officer for
implementation of all the necessary processes for customer service, complaint & grievance
handling.
4 Grievance Officers

4.3 The Grievance Officer for the company would be the Chief Compliance Officer

4.4 The Branch Manager of the Agency branch shall be the officer nominated as the Grievance
Officer for that office.

4.5 The VP Operations shall be the officer nominated as the Grievance Officer for all other
grievance as not addressed to a branch.

4.6 The names and contact details of the Grievance Officers shall be published on the website
of the company.

5 The Customer Service Committee

5.1 The Customer Service Committee comprises of members of the Senior Management of the
IDBI Federal. The customer service committee acts as the Grievance Redressal Committee
of the company.

Chairman Chief Operating Officer

Members Chief Financial Officer,

Head–Legal Secretarial & Compliance,
National Head–Agency & Alliances
President–Bancassurance,
National Head – Marketing & Product,
Appointed Actuary
Secretary VP (Operations) to act as secretary to the
Committee

5.2 Each Member shall appoint a representative from his/her team who can attend the
meetings on their behalf only in case of their absence from the place of such a meeting.
The committee shall consist of all such officers stated above. In case the Chairman is unable to
attend the meeting, the members shall elect a Chairman amongst themselves.

5.3 The Committee may invite any person to be in attendance to assist in its deliberations.

5.4 The Frequency of Meetings shall be at least once in a month.

5.5 All the members/ their representatives should be present to comprise a valid quorum.

5.6 The Committee shall submit a Report on its performance to the Policyholder Protection
Committee of the Board at quarterly intervals.
5.7 Role and functions of the Customer service committee are

1) To put in place proper procedures and effective mechanism to address customer

complaints and grievances of policyholders and prospects, including mis-selling by
intermediaries.
2) To ensure compliance with the statutory requirements as laid down in the regulatory
framework.
3) To review claims intimation, repudiation and special cases, received and requiring
attention.
4) To review the standards for policy holders servicing from time to time.
5) To put in place systems to ensure that policyholders have access to redressal
mechanisms.
6) To address the various compliance issues relating to protection of the interests of
Policyholders.
7) To keep the policyholders well informed and educated about insurance products and
complaint-handling procedures.
8) To address concerns in respect of any special or exceptional cases of complaints / claims
received.
9) Identifying root causes of complaints and initiating process changes, if required.
10) To review existing processes and suggest improvements from time to time.
11) To look into customer complaints involving mis-selling, fraud, etc.; agent related
complaints and complaints made by agents or intermediaries of the Company.
12) Track the processes for handling the issue, verify whether the current process is
followed, and track impact of process changes.
13) To look into the Claims status of the Company from time to time pertaining to
intimation, repudiation, etc.
14) Consider unresolved complaints/grievances escalated to it and offer their advice.
15) To suggest, initiate and monitor projects for improvement of customer service.
16) Prepare Annual Policy holders Report.

6 Policyholder Protection Committee

Policyholder Protection Committee, as stipulated in the guidelines for Corporate Governance
issued by the regulator will be receiving and analyzing the required reports from the
management and will be carrying out all other requisite monitoring activities.
 Grievance Redressal Procedure Manual

1. Grievance Redressal Procedure

The purpose of this procedure manual is to outline the process of receiving the customers’ complaints &
grievance.

The procedure manual covers the following

 Definitions
 Registration of complaints by Customers
 Modes of receipt of complaints
 Categorisation of complaints
 Complaint handling
 Turnaround time for resolution of complaints department wise
 Escalation Matrix department & Overall

2. Definitions

“Complaints/ Grievances ”

A “Grievance/Complaint” is defined as any communication that expresses dissatisfaction about an action

or lack of action, about the standard of service/deficiency of service of the company and/or any
intermediary or asks for remedial action.

Inquiry:
An “Inquiry” is defined as any communication from a customer for the primary purpose of requesting
information about a company and/or its services.

Request:
A “Request” is defined as any communication from a customer soliciting a service such as a change or
modification in the policy.

3. Registration of complaints

The complaints and grievance will be logged in by the following on behalf of the customers
 Bancassurance Channel Partners
 Bancassurance Sales Force
 Branch Operations
 Financial Advisors
 Corporate Agencies & Brokers
 Agency Sales Force

In addition the existing policy holders and prospective customers can directly log in complaints relating
to their policies or proposals.
 4. Modes of receipt

The customer can communicate his complaints/grievance in the following manner

 Send a letter at the registered office “The Grievance Officer, IDBI Federal Life Insurance
Company Ltd, Tradeview, Oasis complex, Kamala City PB Marg, Lower Parel ( West) Mumbai
400 013. “
 Send a email at support@idbifederal.com or grievance@idbifederal.com
 Contact our Call centre at the Toll free Nos 1800 102 5005 ( non MTNL subscribers ) & 1800 22
1120 ( MTNL subscribers)
 Contact the local IDBI Federal Area Agency Head or branch Manager ( Zonal Head is the next
level in escalation)
 Contact the nearest IDBI Bank or Federal Bank branch to forward the same to IDBI Federal.

5. Categorisation of complaints/grievances

Categorisation of complaints as prescribed by the Authority from time to time shall be adopted
by the company and incorporated in their Customer Contact Service System.

The present classification prescribed by the Authority is placed at Annexure B

6. Complaint handling

 In case of email complaints acknowledgement communication sent to client through

support@idbifederal.com and grievance@idbifederal.com
 Complaint is recorded in a system based on mode, category & department for allocation to
concerned teams.
 There is a specified maximum turnaround time for each team depending on type of
complaints.
 All the complaints received at the agency branches and partner banks should be forwarded
to the Customer Support team at Head office. The communication related to the
acknowledgment and resolution will be sent from the Customer Support team at HO.
 Operations & distribution channel related complaints are resolved by concerned
departments , revert goes back to the support team and is logged in the system.
 In case the client had contacted through call centre, the call centre will call the client and
inform him about the resolution.
 For legal complaints, these are routed to Corporate Legal department & the resolution is
done with their help in wording the communication.
 In case of complaints where the clients allege Unfair business practices, Misselling, Fraud or
Forgery the case will be forwarded to the Compliance and Legal department for
investigation and appropriate action
 After investigation with its findings and recommendations the report will be placed before
the Committee for taking appropriate decision.
 The Customer Service Committee acts as a Grievance redressal committee.
  For complaints not resolved within the defined Turnaround time automatic escalations are
made to next level in the escalation matrix and finally to Grievance Redressal Committee.
 On resolution of all complaints a written communication is sent to client by the Manager-
Customer & Sales support.

7. Closure of grievance:
 A complaint shall be considered as disposed of and closed when
(a) the company as acceded to the request of the complainant fully.
(b) where the complainant has indicated in writing, acceptance of the response of the
company.
(c) where the complainant has not responded to the company within 8 weeks of the
company’s written response.
(d) where the Grievance Officer has certified that the company has discharged its
contractual, statutory and regulatory obligations and therefore closes the complaint.

8. Turnaround Time

Departments Inquiry Servicing Complaint/ Responsible

request Grievance
Call centre 1 day 7 days 10 days Manager-Customer & sales
support
Email 2 days 7 days 10 days Manager-Customer & sales
support
New Business 2 days 7 days 10 days Sr. Manager- New Business

Policy servicing 3 days 7 days 10 days Manager- Policy Servicing

Claims 3 days 7 days 15 days Sr Manager-Claims

Channel support 3 days 7 days 10 days Sr. Manager- Channel
support
Underwriting 2 days 7 days 10 days Head - Underwriting
Agency sales 2 days 7 days 10 days Manager- Agency Sales
support Support
Banca sales 2 days 7 days 10 days Manager- Banca Sales
support Support

 Each of the departmental managers is responsible for the Turnaround times for the queries,
complaints & grievances.
 In case they are unable to resolve the same within promised Turnaround time , they have to
escalate to the next level as per the Escalation matrix
 There is a system in place to monitor the Turnaround time and mark cases which are beyond the
promised Turnaround time for the category.
 There are two types of turnaround times involved.
(i). The service level turnaround times, which are mapped to each classification of complaint (
which is itself based on the service aspect involved).
 (ii). The turnaround time involved for the grievance redressal.
 As to (i), the TATs are as mapped to the classification and prescribed by the regulator to the
company. These TATs reflect the time-frames as already laid down in the IRDA Regulations for
Protection of Policyholders Interests and more, as, wherever considered necessary( for certain
service aspects not getting specifically reflected in the regulations), specific TATs are indicated in
the classification and mapping provided by the regulator in Annexure A & B
 As regards (ii) above, the minimum TATs required to be followed shall be as prescribed in
guidelines published by the regulator.

9. Escalation Matrix

The following are the various levels as per the escalation matrix
First Second Level Third Level Final Level
level
Operations Manager- VP Operations Grievance Officer Grievance
Customer Redressal
& Sales Committee
support
Agency Channel Manager- Zonal Head Grievance Officer Grievance
Agency Redressal
Support Committee
Banca Channel Manager- Zonal Head Grievance Officer Grievance
Banca Redressal
Support Committee
Complaints received at Customer VP Operations Grievance Officer Grievance
Agency Branches/ Partner Support Redressal
Bank branches team – Committee
Head
office

All requests for compensation by the customers should be represented to the Chief Operating Officer
along with the recommendations of the Channel Heads. The Chief Operating Officer will be approving
all compensation requests based on the Compensation Policy of the company.

In case of deviation from internal process and if it has any compliance implication, then the same needs
to be approved by Compliance.

10. Adherence to IRDA’s Policy holders protection regulations

We have also ensured adherence to the Policy holders protection regulations while designing
and implementation of policy holder’s communication and documentation as well as our
internal processes. The details are placed in Annexure A.
 Annexure A

COMPLIANCE CHECKLIST

IRDA (Protection of Policyholder’s Interests) Regulations, 2002

# Requirement Mode of compliance Status

1 Reg 2(e): Prospectus to be issued to the The Brochures provided by the Complied
customers. The same shall contain particulars Company details the product
mentioned in rule 11 of the Insurance Rules, 1939. and the riders
It should also specify riders and its benefits.
2 Reg 3(1): The Prospectus shall clearly state the The Brochure clearly states the Complied
scope of benefits, the extent of insurance cover, scope of benefits, insurance
the warranties, exceptions and conditions of the cover and other details
insurance cover, whether the product is mandated.
participating (with-profits) or non-participating
(without-profits).
The Prospectus shall also spell out the rider/s and The Brochure details the riders
its scope of benefits. and its benefits.
The premium for health or critical illness riders in The rider/s is/are structured to
case of term or group products shall exceed 100% ensure compliance with these
of the premium under the basic products. requirements.

Total rider premium shall not exceed 30% of the

premium of the basic product. Any benefit arising
under each of the riders shall not exceed the sum
assured under the basic product.

The benefit amount under riders shall be subject

to section 2(11) of the Insurance Act 1938 (“Act”)
3 Reg 3(2): The insurer/agent/ other intermediary All sales tools are prepared to Complied
shall provide all material information in respect of
ensure clear and qualitative
a proposed cover to the prospect to enable the communication. Further, this
prospect to decide on the best cover that would be
perspective is imbibed during
in his or her interest training and other meetings.
4 Reg 4(1): The proposal form shall be in writing and
Copy of the proposal form is Complied
a copy of the same shall be provided free of cost to
provided to the customer free of
the customer within 30 days of acceptance. cost.
5 Reg 4(2): Forms and documents shall be provided Company has the necessary Complied
in languages mentioned in the Constitution of facilities to provide such forms
India. and documents upon customer
request.
6 Reg 4(3): The proposal form shall prominently The proposal form used by the Complied
state the requirements of Section 45 of the Act. Company states the
 requirements of section 45
7 Reg 4(5): The insurer shall encourage the proposer The proposal form specifically Complied
to appoint nominee/s. provides for nomination.
Further, this requirement is also
checked at the underwriting
stage.
8 Reg 4(6): The decisions on the proposal form shall The Company has 15 days turn- Complied
be communicated to the customer in not more around-time for the said
than 15 days. requirement.
9 Reg 6(1): The insurance policy shall state the The Company forwards the Complied
following: policy to the customer in a
docket form, which meets all
(a) name of the plan and its terms & conditions; the mandated requirements

(b) whether participatory or not;

(c) specify the basis of participation

(d) benefits payable, the contingencies triggering

payment and other terms & conditions;

(e) details of the riders;

(f) specify the dates such as commencement of

risk, maturity, payment of benefits;

(g) state the premiums payable, periodicity, grace

period, date of last installment, the implication
of discontinuing the payment and provisions on
guaranteed surrender value.

(h) age at entry and whether the same has been

admitted;

(i) policy requirements for (a) conversion into paid

up policy, (b) surrender (c) non-forfeiture and
(d) revival;

(j) exclusion of contingencies from the cover, both

in main policy and riders;

(k) provision for nomination, assignment, and

loans on security of the policy and a statement
on the insurer’s right to prescribe the rate of
 interest on the loan;
(l) special clauses or conditions, such as, first
pregnancy clause, suicide clause etc.;
(m) insurer’s address for communications; and
(n) documents to be submitted in support of a
claim.
10 Reg 6(2): When the policy is forwarded to the
customer, the covering letter should state that the
customer may cancel the policy within 15 days of
receipt of the same, if he disagrees with any of the
terms. The amounts deductable in such cases will
be proportionate risk premium, cost of medicals &
stamp duty.
11 Reg 6(3): In case of ULIPs, the insurer shall also
state that it is entitled to repurchase the units as
on the date of free-look cancellation.
12 Reg 6(4): When premium is dependent on age, the
insurer shall ensure that the age is admitted before
the issuance of the policy. If age is not admitted,
the insurer shall obtain proof of age.
13 Reg 8(1): The policy shall state the documents to
be submitted in support of the claim.
14 Reg 8(2): Any query / additional documents
required to process a claim shall be raised at once
within 15 days of receipt of claim.
15 Reg 8(3): A claim shall be paid within 30 days of
receipt of relevant papers. However, if any
investigation is required, the same shall be
completed within 6 months of the claim.
16 Reg 8(4): If the claim amount cannot be paid due
to lack of identification of the claimant, the claim
amount shall be held by the insurer together with
interest at the savings account rate of a scheduled
bank. The interest shall be payable from the 30 day
of submission of all relevant papers.
17 Reg 8(5): In case of delay in processing the claim,
the insurer shall pay interest 2% above the bank
rate prevalent at the beginning of the FY.
The Company forwards the Complied
policy with a welcome letter,
which provides for a free-look
cancellation period of 15 days.
The welcome letter issued by Complied
the Company specifically
provides for such a clause.
The said requirement is ensured Complied
at the underwriting stage.
The policy document issued by Complied
the Company to the customer
states such requirement.
The Company has internal turn- Complied
around-time mechanisms to
meet this requirement.
The Company has internal turn- Complied
around-time mechanisms to
meet this requirement.
The Company has made Complied
arrangements for the said
requirement.
The Company has internal turn- Complied
around-time mechanisms to
ensure that the claims are paid
on time. However, in case of
delay the Company shall comply
 with the mandated
requirement.
18 Reg 10: The insurer shall respond within 10 days of The Company has customer Complied
receipt of any of the following communication: service systems to ensure
compliance with this
(a) recording change of address; requirement.

(b) noting a new nomination or change of

nomination under a policy;

(c) noting an assignment on the policy;

(d) providing information on the current status of a

policy indicating matters, such as, accrued
bonus, surrender value and entitlement to a
loan;

(e) processing papers and disbursal of a loan on

security of policy;

(f) issuance of duplicate policy;

(g) issuance of an endorsement under the policy;

noting a change of interest or sum assured or
perils insured, financial interest of a bank and
other interests; and

(h) guidance on the procedure for registering a

claim and early settlement thereof.
19 Reg 11(1): The insurer has to disclose ‘material Company ensures that the Complied
information’. ‘material information’ is
disclosed to the customer by
ensuring compliance with the
applicable regulations, following
industry practice and internal
systems.
 Annexure B

LIFE CLASSIFICATION OF COMPLAINTS – IRDA GUIDELINES

LIFE INSURANCE COMPLAINTS CLASSIFICATION

S.N Description Mapping of PPI Provisions to Servicing TATs

o. classification structure
(1) PROPOSAL PROCESSING INCLUDING REFUNDS -Proposal (NB) Related issues (from
receipt of proposal until results in to policy) including Refunds
1 Proposal papers 4 (6) Proposals shall be processed by the 15 days
submitted but misplaced insurer with speed and efficiency and all
by Insurer decisions thereof shall be communicated
by it in writing within a reasonable
period not exceeding 15 days from
receipt of proposals by the insurer.
2 Cancellation of proposal Refer S.No.1 15 days
& refund of deposit at
proposal stage not
attended
3 After submission of Refer S.No. 1 15 days
proposal to the insurer
no response received
regarding
acceptance/further
requirements/rejections.
4 After Submission of all Refer S.No. 1 15 days
requirements,no
communication was
received.
5 Excess Propasal deposit Refer S.No. 1 10 days
not refunded
6 Policy bond not received. 10 (1) An insurer carrying on life or 10 days
general business, as the case may be,
shall at all times, respond within 10 days
of the receipt of any communication
from its policyholders in all matters.
7 Mistake in age. 6 (1) A life insurance policy shall clearly 10 days
state:
(a) the name of the plan governing the 10 days
policy, its terms and conditions;
(b) whether it is participating in profits 10 days
or not;
(c) the basis of participation in profits 10 days
such as cash bonus, deferred bonus,
simple or compound reversionary bonus;
(d) the benefits payable and the 10 days
contingencies upon which these are
payable and the other terms and
conditions of the insurance contract;
(e) the details of the riders attaching to 10 days
the main policy;
(f) the date of commencement of risk 10 days
and the date of maturity or date(s) on
which the benefits are payable;
(g) the premiums payable, periodicity of 10 days
payment, grace period allowed for
payment of the premium, the date the
last installment of premium, the
implication of discontinuing the payment
of an installment(s) of premium and also
the provisions of a guaranteed surrender
value.
(h) the age at entry and whether the 10 days
same has been admitted;
(i) the policy requirements for (a) 10 days
conversion of the policy into paid up
policy, (b) surrender (c) non-forfeiture
and (d) revival of lapsed policies;
(j) contingencies excluded from the 10 days
scope of the cover, both in respect of
the main policy and the riders;
(k) the provisions for nomination, 10 days
assignment, and loans on security of the
policy and a statement that the rate of
interest payable on such loan amount
shall be as prescribed by the insurer at
the time of taking the loan;
(l) any special clauses or conditions, 10 days
such as, first pregnancy clause, suicide
clause etc.; and
(m) the address of the insurer to which 10 days
all communications in respect of the
policy shall be sent.
 (n) the documents that are normally 10 days
required to be submitted by a claimant
in support of a claim under the policy.
8 Mistake in Date of 10 days
Commencement (DOC). Refer S.No. 6
9 Mistake in Term of the 10 days
policy. Refer S.No. 6
10 Mistake in name of the 10 days
Nominee/ Beneficiary. Refer S.No. 6
11 Mistake in Date of 10 days
Maturity
(DOM)/DOLP/others. Refer S.No. 6
12 Mistakes in the name 10 days
and address of the
insured. Refer S.No.6
13 Mistakes in any other 10 days
policy schedule item. Refer S.No. 6
14 Mode of payment not 10 days
shown correctly. Refer S.No. 6
15 Next Premium due is not 10 days
shown correctly. Refer S.No. 6
16 Wrong Policy Bond is 10 days
issued Refer S.No. 10(1)
(2) POLICY SERVICING DELAYS/DENIALS - Policy Servicing issues related to service / delays
excludig S.V., S.B, Maturity claims and Death claims
17 No Response for 10 days
recording Change of
address 10 (1) (a) recording change of address;
18 No Response for noting 10 days
nomination/ change of 10 (1) (b) noting a new nomination or
nomination change of nomination under a policy;
19 No response for noting 10 days
an assignment 10 (1) (c) noting an assignment on the
/reassignment policy;
20 Statement of account 10(1) d Providing information on the 10 days
not received current status of a policy indicating
matters,such as accrued bonus
surrender value and entitlement to loan;
21 Premium payment 10 days
position statement not
received Refer S.No. 20
22 Response for issuance of 10 days
duplicate policy is not 10 (1) (f) issuance of duplicate policy;
 sent

23 Payment of premium not 10 days

acted upon or wrongly
acted upon including Top
up premium / Premium
Redirection. Refer S.No. 20
24 Reinstatement 10 days
requirements raised by
Insurer not acceptable Refer S.No. 20
25 Requirements for revival 10 days
not communicated or
raised Refer S.No.20
26 Non-receipt of Premium 10 days
receipt Refer S.No. 20
27 Non-receipt of Duplicate Refer S.No. 10(1)(f)issuance of duplicate 10 days
policy policy;
28 Insurer failed to send 10 days
lapse intimation Refer S.No. 20
29 After submission of all 10 days
reinstatement (revival)
requirements, there is no
response from the
Insurer. Refer S.No. 20
30 Request for Servicing 10 days
Branch transfer is not
effected Refer S.No. 6
31 Auto Cover continuation 10 days
option not
effected/Applicable for
conventional and ULIP
cases. Refer S.No. 6
32 Policy conversion option 10 (1) (g) issuance of an endorsement 10 days
not effected under the policy; noting a change of
interest or sum assured or perils insured,
financial interest of a bank and other
interests.
33 Policy Benefit option not 10 days
effected Refer S.No. 32
34 Alteration in policy not 10 days
effected. Refer S.No. 32
35 Dispute concerning 10 days
statement of account or Refer S.No. 20
 premium position
statement
36 Response for processing 10 days
or payment of Policy
Loan is not sent Refer S.No. 20
37 Reinstatement denied Refer S.No. 6 10 days
(3) SURVIVAL CLAIMS - S.B claims / Maturity claims / S.V. payment & connected issues
including (Pension) Annuity Payments
38 Surrender Value not paid Refer S.No. 20 10 days
39 Disputes concerning 15 days
correctness of surrender
value Refer S.No. 20
40 Disputes concerning 15 days
eligibility of surrender
value Refer S.No. 20
41 Survival Benefit is not 8 (2) A life insurance company, upon 15 days
paid receiving a claim, shall process the claim
without delay. Any queries or
requirement of additional documents, to
the extent possible, shall be raised all at
once and not in a piece-meal manner,
within a period of 15 days of the receipt
of the claim.
42 Maturity claim is not 15 days
paid Refer S.No. 41
43 Annuity/pension 15 days
instalments not paid Refer S.No. 41
44 Commutation value/cash 15 days
option not paid Refer S.No. 41
45 Dispute concerning claim 15 days
value Refer S.No. 41
46 Non-payment of penal 8 (4) Subject to the provisions of section
interest 47 of the Act, where a claim is ready for
payment but the payment cannot be
made due to any reasons of a proper
identification of the payee, the life
insurer shall hold the amount for the
benefit of the payee and such an
amount shall earn interest at the rate
applicable to a savings bank account
with a scheduled bank (effective from 30
days following the submission of all
papers and information).
 (5) Where there is a delay on the part of 15 days
the insurer in processing a claim for a
reason other than the one covered by
sub-regulation (4), the life insurance
company shall pay interest on the claim
amount at a rate which is 2% above the
bank rate prevalent at the beginning of
the financial year in which the claim is
reviewed by it.
(4) DEATH CLAIMS - Death Claims & Connected Issues
47 Requirement in respect 15 days
of Death Claim not
raised by Insurer Refer S.No. 41
48 Death claim not paid / 8 (3) A claim under a life policy shall be 30 days
disputed paid or be disputed giving all the
relevant reasons, within 30 days from
the date of receipt of all relevant papers
and clarifications required. However,
where the circumstances of a claim
warrant an investigation in the opinion
of the insurance company, it shall
initiate and complete such investigation
at the earliest. Where in the opinion of
the insurance company the
circumstances of a claim warrant an
investigation, it shall initiate and
complete such investigation at the
earliest, in any case not later than 6
months from the time of lodging the
claim.
49 Death claim investigation 6 months
not completed Refer S.No. 48
50 Non-payment of penal 15 days
interest in case of Death
claim Refer S.No. 46
51 Repudiation of Claim not Refer S.No. 48 10days
communicated after
investigation
(5)Insurers' Unfair Business Practices/ Mis sales / Mis representation /
Tampering Records/Forging Signature etc 10 days
52 Product differs from 3 (1) a prospectus of any insurance 10 days
what was requested or product shall clearly state the scope of
disclosed. benefits, the extent of insurance cover
and in an explicit manner explain the
warranties, exceptions and conditions of
the insurance cover and, in case of life
insurance, whether the product is
participating (with-profits) or non-
participating (without-profits). The
allowable rider or riders on the product
shall be clearly spelt out with regard to
their scope of benefits, and in no case,
the premium relatable to health related
to critical illness riders in the case of
term or group products shall exceed 100
per cent of premium under the basic
product. All other riders put together
shall be subject to a ceiling of 30 per
cent of the premium of the basic
product. Any benefit arising under each
of the riders shall not exceed the sum
assured under the basic product.
(2) An insurer or its agent or other 10 days
intermediary shall provide all material
information in respect of a proposed
cover to the prospect to enable the
prospect to decide on the best cover
that would be in his or her interest.
(3) Where the prospect depends upon 10 days
the advice of the insurer or his agent or
an insurance intermediary, such a
person must advise the prospect
dispassionately.
(4) Where, for any reason, the proposal 10 days
and other connected papers are not
filled by the prospect, a certificate may
be incorporated at the end of proposal
form from the prospect that the
contents of the form and documents
have been fully explained to him and
that he has fully understood the
significance of the proposed contract.
 (5) In the process of sale, the insurer or 10 days
its agent or any intermediary shall act
according to the code of conduct
prescribed by:
i) the Authority 10 days
ii) the Councils that have been
established under section 64C of the Act
and
iii) the recognized professional body or
association of which the agent or
intermediary or insurance intermediary
is a member.
53 Term(Period) of the 10 days
policy is different/altered
without consent Refer S.No. 52
54 Mode of premium 10 days
payment differs from
requested or disclosed Refer S.No. 52
55 Annuity/Commutation/C 10 days
ash Option /Rider/other
Options not included as
requested Refer S.No. 52
56 Proposed Insurance not 10 days
in the interest of
proposer Refer S.No. 52
57 Intermediary did not 10 days
provide material
information concerning
proposed cover Refer S.No. 52
58 Single premium Policy 10 days
issued as Annual
premium policy Refer S.No. 52
59 Tampering, Corrections, 10 days
forgery of proposal or
related papers Refer S.No. 52
60 Credit/Debit card 10 days
debited without consent
of Consumer Refer S.No. 52
61 Premium paying period 10 days
projected is different
from actual Refer S.No. 52
62 False promises made 10 days
regarding surrender Refer S.No. 52
 value by intermediers

63 Free-look refund not 6 (2) While forwarding the policy to the 10 days
paid insured, the insurer shall inform by the
letter forwarding the policy that he has a
period of 15 days from the date of
receipt of the policy document to review
the terms and conditions of the policy
and where the insured disagrees to any
of those terms or conditions, he has the
option to return the policy stating the
reasons for his objection, when he shall
be entitled to a refund of the premium
paid, subject only to a deduction of a
proportionate risk premium for the
period on cover and the expenses
incurred by the insurer on medical
examination of the proposer and stamp
duty charges.
(3) In respect of a Unit Linked Policy, in 10 days
addition to the deductions under sub-
regulation (2) of this regulation, the
insurer shall also be entitled to
repurchase the unit at the price of the
units on the date of cancellation.
Cancellation of policy 10 days
other than Free Look
64 Period not responded. Refer S.No.6
65 Advice concerning 10 days
Exclusions/limitations of
cover not communicated Refer S.No. 52
66 Illegitimate inducements 10 days
offered Refer S.No. 52
67 Malpractices or unfair
business practices Refer S.No. 52
68 Misappropriation of 10 days
premiums Refer S.No. 52
(6)UNIT LIKED POLICIES- Complaints regarding Charges,
Improper Allocation of Units, NAV Related Complaints Switching and
Partial Withdrawals 10 days
69 Disputes concerning NAV Refer S.No. 6 10 days
70 Charges recovered in 10 days
violation of regulations Refer S.No. 6
71 Complaints related to 10 days
improper allocation of
Units Refer S.No. 6
72 Disputes concerning 10 days
switching Refer S.No. 6
73 Hidden charges not
explained to Consumer Refer S.No. 52
74 Partial withdrawal 10 days
benefit not paid Refer S.No. 41
75 Poor disclosures of 10 days
various Charges Refer S.No. 52
76 Foreclosure notice not 10 days
given to
policyholder/forefuture
of premium not
communicated to policy
holder. Refer S.No. 6
77 Disputes concerning pre- 10 days
existing illnesses not
covered Refer S.No. 6
78 Disputes concerning 10 days
policy privileges denied Refer S.No. 52
79 Definitions of eligibility 10 days
misinterpreted Refer S.No. 52
80 Claim benefit excluded 10 days
due to policy definition Refer S.No. 52
81 Disputes concerning the 10 days
limits of expenses
including deductible Refer S.No. 6
7 Distant Marketing / Call centre Marketing / Website Marketing

82 The insurer calls for 10 days

solicitation of business in
spite of client registered
in DNC (Regulation of
TRAI will also apply) Refer S.No.52
83 Insurer making repeated 10 days
and unsolicited calls Refer S.No.52
84 Mis-selling on distant 10 days
calling Refer S.No.52
85 Explaining excessive 10 days
features of a policy to a
prospect on calls Refer S.No.52
86 Insurers debiting the 10 days
premium on cards
arbitrarily Refer S.No.52
87 Insurers not refunding 10 days
the money debited
arbitrarily on credit cards Refer S.No.52
88 Proposal form not 10 days
collected by Insurer
within stipulated period
(case of misselling)
through telecall system. Refer S.No.52
89 Issues pertaining to c all 10 days
centers (poor response
by call center) Refer S.No.52
(8) OTHERS-Other Issues not covered under headings 1 to 7
90 Advertisements
regulations violation
91 Violation of other IRDA
regulations
92 Complaint raised with 10 days
Insurer not addressed Refer S.No. 6